Cornea

Herpes Zoster Virus Eye Disease

Overview

Herpes zoster, commonly known as "shingles," is a viral disease that causes a characteristic skin rash of small fluid-filled blisters (vesicles) which form scabs and can leave permanent scars. Varicella-zoster, the virus that causes chicken pox, is responsible for herpes zoster. When it occurs around the eye, it is called herpes zoster ophthalmicus (HZO) and it is termed herpes zoster keratitis when it involves the cornea.

 

Herpes zoster commonly attacks the nerves around the eye, especially the nerve that supplies the upper eyelid and forehead. If the virus affects the nerves that go directly to the eyeball, it can cause serious eye problems including corneal ulcers, inflammation in the front or back of the eye, and also glaucoma. These problems may appear at the same time as the skin rash, or weeks after the vesicles have disappeared. Injured sensory nerves may cause lingering pain and may be sensitive for years after the viral attack.

Symptoms

Symptoms of herpes zoster may include:

  • Tingling or burning sensation of the scalp, forehead, or cheeks

  • Painful one-sided rash in the scalp, forehead, and around the eye

  • Redness of eye

  • Foreign body sensation of the eye

  • Light sensitivity

  • Blisters

  • Eye pain

  • Discharge from the eye

  • Mild to severe vision decrease

Risk Factors

People at risk for herpes zoster include:

  • Prior chicken pox

  • Increasing age

  • Immunocompromised state

  • Chemotherapy or radiation therapy

Complications

Corneal transplant (PK) surgery may be indicated in severe corneal scarring, irregular corneal surface, corneal ulceration, and perforation. Other potential complications are iritis/uveitis, retinal inflammation, severely decreased vision, or blindness. Shingles may also cause chronic skin sensitivity or pain, termed postherpetic neuralgia (PHN).

Treatment

If the infection is caught within the first few days of the rash, shingles is treated with a 7-10 day course of antiviral pills. Steroid drops are indicated if there is significant eye inflammation; they often need to be decreased very slowly, frequently over months to years. Post-herpetic neuralgia (PNH) may need to be treated with creams or systemic medication and sometimes by a pain management specialist if the pain is severe.

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